One in three patients who recover from coronavirus could be harmed for life, with long-term damage to their lungs, as well as chronic fatigue and psychological disturbances. Photo / 123rf
One in three patients who recover from coronavirus could be harmed for life, with long-term damage to their lungs, as well as chronic fatigue and psychological disturbances. Photo / 123rf
One in three patients who recover from coronavirus could be harmed for life, with long-term damage to their lungs, as well as chronic fatigue and psychological disturbances, research suggests.
Experts said there was growing evidence that the virus could cause persistent or even permanent trauma, including impairment to the brain and an increased risk of Alzheimer's disease.
NHS guidance seen by Britain's Daily Telegraph suggests around 30 per cent of patients who recover from Covid-19 may be left with damaged and scarred lung tissue, if it follows patterns of similar diseases.
This could amount to around 100,000 of the 300,000 people who have so far tested positive in the UK. Limited testing during the pandemic means the figure may be still higher.
Some estimates suggest around 3.5 million people in the UK are likely to have been infected by Covid, meaning that more than one million could be left facing long-term consequences.
In an interview with the Telegraph, the head of the new NHS centre for Covid recovery said she was worried about how little was known about just how long the consequences may last.
Dr Hilary Floyd, clinical director at the NHS Seacole Centre, said she had been shocked by how young many of its patients were, with healthy people who were in their 40s and 50s when the virus struck now facing long-term fatigue and disability.
Dr Floyd told the Telegraph: "These are people who were independent, they might be running their own business, going to the gym, swimming, active - now they are at the point they can't get out of bed.
"We have a couple of patients in their 40s at the moment; we really didn't expect that. We were expecting them to be older, we have seen a lot in their 50s and 60s who are really struggling particularly because their expectation of getting back to normal is much greater."
She added: "They may always have some level of debilitation."
The NHS guidance for GPs and community services warns that up to half of patients treated in intensive care units for the virus may be left with "persistent physical, cognitive and psychological impairments", including chronic fatigue.
So far around 13,000 patients have received such treatment. And one in 10 of those discharged from hospitals in England after treatment for Covid-19 has been left with acute heart injury, it says.
In many cases the fatigue and breathlessness is so severe that patients are only able to do short bursts of 10 minutes supervised activity at a time, Dr Floyd said.
Many patients are also struggling to cope with the psychological impact from the changes to their health, with therapists on site, she said, adding: "There is a lot of anxiety."
For clinicians, the most frightening aspect of the crisis is that so little is known about the long-term consequences of the virus, she suggested.
"We don't know how long-term long term is. We don't know if the generation who is in their 50s and 60s now will be much more frail or have an increased risk of dementia in 20 years' time."
The centre, based at Headley Court, Surrey, formerly a disused military hospital, opened four weeks ago, and will be able to treat up to 300 patients ultimately.
Prof Peter Openshaw, who sits on the Government's New and Emerging Respiratory Virus Threats Advisory Group (Nervetag), said: "We are quite alarmed about the number of people needing follow-up treatment after being hospitalised.
"Many are suffering quite prolonged effects, particularly those who had severe disease."
He said that intensive care patients would normally take about a year to get back to full health, while some never did.
Prof Openshaw, an immunologist at Imperial College London, said there was particular concern about patients who suffered extensive blood clots, which can cut off blood supply to parts of the lungs, leading to a slow recovery.
Others were found to be suffering "chronic scarring pneumonia" due to inflammation of the lungs, he said.
The immunologist said the picture of long-term effects was only beginning to become clear, saying he believed that around one in 10 of patients hospitalised with the disease would have "quite persistent problems".
The guidance issued by NHS England to primary care and community services, involving GPs and other providers of care outside hospitals, suggests that almost one in three people who suffer from Covid could suffer long-term damage, if it follows patterns seen by similar viruses.
"Approximately 30 per cent of survivors of the global Sars outbreak caused by Sars-CoV and the Middle East respiratory syndrome coronavirus (Mers-CoV) experienced persistent physiological impairment and abnormal radiology consistent with fibrotic lung disease. It is envisaged that pulmonary fibrosis [lung damage and scarring] is likely to be an important sequela/condition which is the consequence of Covid-19," it states.
'We are learning on the hoof'
Health officials will next month launch a recovery programme for all patients who have suffered from Covid. A website will provide advice for anyone struggling to recover from the virus, track symptoms, and direct those who need specific rehabilitation help towards the right treatment.
The NHS guidance suggests that one in seven cases treated by ICU units could be left with long-term or permanent brain damage. Seventy per cent of all such patients will suffer delirium, and in one in five cases, this will become "established cognitive impairment" the document warns.
Mild damage in brain functioning may be seen in about one quarter of patients who have suffered acute respiratory distress, it says. And it warns that this in turn may increase the risk of degenerative diseases such as Alzheimer's.
Experts are particularly concerned about the risk of prolonged or chronic fatigue, saying prompt treatment is needed to reduce the risk of long-term syndromes.
Dr Janet Scott, an post-viral sequelae expert and clinical lecturer at the University of Glasgow-MRC Center for Virus Research, said: "With Covid-19, the principal problems are likely to be respiratory so we can draw from what happens to other people who have had similar respiratory problems.
Photo / 123rf
"Forty per cent of those who have Acute Respiratory Disease Syndrome, which people with Covid-19 have been getting, have problems coping with daily activities afterwards.
"With Sars, a proportion had problems up to two years later."
Dr Scott added: "Some will get post-traumatic stress, anxiety or depression. Some chronic fatigue syndrome patient groups fear there will be a peak of ME, but not all post viral fatigue is Chronic Fatigue Syndrome – and it will be important to diagnosis the underlying cause of any fatigue – even if longer lasting."
But she said the lack of testing in hospitals had hindered efforts to establish the scale of long-term complications.
Lessons from other diseases suggested that long-term ill-effects could be widespread, she suggested.
"Post-Ebola, every survivor was impacted in some way and 70 per cent were left with a pain syndrome. Around 80 per cent had a moderate or severe disorder compared to about 11 per cent in the normal population," she said.
rof John Hurst, professor of respiratory medicine at University College London, said that while the NHS had organised well to cope with the acute epidemic, there had been too little planning to respond to the long-term needs of those struggling to recover from Covid.
"In north London, we have been following people up by phone, predominantly, and are finding that around one in five have ongoing symptoms four to six weeks later.
"They include breathlessness and coughing but also fatigue, which comes through really strongly."
Prof Hurst, a member of the British Thoracic Society's science and research committee, added: "We would expect that a proportion will go on to have lung fibrosis . What we want to do is identify them early but there is no central way of doing that, we are learning on the hoof."
'I actually wrote my will'
Louise Barnes, 46, from Suffolk, is among the many patients who are still paying the price of contracting suspected coronavirus three months on.
The former teacher has described the "terrible" symptoms she still suffers, including night shakes so violent she likened them to a seizure, nausea, tinnitus and tightness in the chest.
Barnes, a so-called "long tail" patient, was only swabbed once for Covid because in the early days, hospitals were not routinely testing suspected cases.
She said the long-term effects had evoked such feelings of loneliness that she set up a support group online, which has almost 1000 members, almost all of whom are experiencing similar effects.
"It was just assumed, when I first fell ill, that you would go on to recover. People were talking about recovery within one or two weeks but what's actually still happening is really frightening."
Barnes, who has an autoimmune condition, first developed Covid symptoms on March 18, including a piercing "ice pick" headache, scratchy sore throat and tightness in her chest.
After speaking to NHS 111 and completing an online assessment, an ambulance came to her house and ended up taking her to hospital due to her fever and she was kept in overnight.
She was swabbed and sent home the next day but never got the result as the test proved faulty. But she has continued to suffer and has twice returned to hospital.
Photo / 123rf
"The pressure on my lungs was horrendous," she said. "I actually wrote my will. I didn't think I'd survive it at all."
She said many members of her post-Covid group had had antibody tests but that the results almost always came back negative, even for those diagnosed with the virus.
"It's very lonely," she added. "There is not much support and we need more help. How many others out there are feeling like this and think it's just them?
"A lot of people's family don't believe that they are still ill. The symptoms come and go but I don't seem to be getting better and am very concerned about the future."
'I was short of breath for months'
Prof Peter Piot, director of the London School of Tropical Medicine, is one of the world's leading experts in viruses.
He fell ill with Covid three months ago, with a high fever and splitting headaches, and was admitted to hospital for oxygen treatment. Prof Piot is among those who suffered long-term consequences for months.
He said many others - potentially including Boris Johnson, who was in intensive care with Covid - may struggle to get over the illness, and be left feeling drained of energy.
"Many people have after the acute phase … after the virus is being brought under control, it has long-term consequences. In my case, my lungs became rigid, and that was as a result of the inflammatory response of the body. That caused me to be short of breath for months and so many people have other problems, chronic lung problems, kidney failure," he told the BBC Andrew Marr show.
Asked whether the Prime Minister was likely to be able to cope with the sort of hours demanded by his job, having been critically ill with Covid, Prof Piot said it "it all depends how good a team you have around you."
He said: "It's certainly not exactly the same type of energy that you can put in [afterwards]. But you know things are really improving quite rapidly in some cases; not at all in others. Some people will have months and months of chronic fatigue. I'm not familiar with the Prime Minister's condition so I don't know."
